Healthcare Provider Details

I. General information

NPI: 1255516977
Provider Name (Legal Business Name): REGINA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 NININGER RD
HASTINGS MN
55033-1056
US

IV. Provider business mailing address

1175 NININGER RD
HASTINGS MN
55033-1056
US

V. Phone/Fax

Practice location:
  • Phone: 651-480-4100
  • Fax: 651-480-4490
Mailing address:
  • Phone: 651-480-4100
  • Fax: 651-480-4490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberMN20888
License Number StateMN

VIII. Authorized Official

Name: MR. ERNEST G ENCK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CEO
Phone: 651-480-4116